Organisational Development Matters

Project outline 

Within the wider context of the Integration of Health & Social Care, in 2015 NHS Lothian, in collaboration with the four Health & Social Care Partnerships within the Lothian area, set out to provide a Development Toolkit for Integrated Teams which would develop a person-centred team working culture and support the vision, values and strategic plans of each Partnerships.

It was recognised that improved outcomes for service users would only be achieved by supporting frontline teams to come together and develop new ways of working to deliver better outcomes for their service users. This would require a new approach to team development which recognised the challenges of different organisational cultures coming together, time pressures on teams to devote to development and capacity pressures on organisational development teams to provide facilitation for a range of needs. 

We found that there was nothing available on the market which would meet all of these requirements and whilst we had the ability to design our own materials in-house, we did not have the capacity so we had to think of an alternative solution. 

At that time, OD transition monies became available from the Scottish Government and so by each HSCP pooling resources, an external, bespoke commission was made possible. 

After a long development journey, the Toolkit is now available on-line and hard copy format and includes the following modules: 

• Leadership
• Culture, Vision & values
• Change and transition
• Communication and collaboration
• Risk and Innovation
• Roles and responsibilities
• Monitoring progress 

Each module has a clear format of: 

• A diagnostic - to enable teams to identify for themselves their collective priorities for development
• Theory a little bit
• A range of tools which can be used in a given situation and tips for their use.
• Workshop outlines for half day, full day or shorter sessions 

The aim of this project was to produce a toolkit of resources for teams and make them available - this has been achieved. 

We are currently recruiting participants for the 4th Cohort of a jointly-delivered programme to support team leaders from across the health & social care system in the Lothians to help them gain confidence in using the toolkit.  

This consists of a one-day development workshop sandwiched between 2 development conversations with the team leaders manager and some pre-work. There is a follow-up half- day workshop. 

All participants have access to the Toolkit in advance of the programme.  There is also be coaching support from OD, and team leaders identify a buddy from the programme for mutual support. 

The outcome of the programme is the creation of a team development plan that will support participants to develop their team. Those with an iMatter Team Action Plan will find this complimentary. iMatter is the NHSScotland Staff Experience tool.

In the workshop participants will get an overview of the whole toolkit, experience a number of exercises from the toolkit and discuss how they might use them in their own teams. There will also be sessions on the skills required by team leaders to facilitate this kind of work with their teams. 

Outline your planning and implementation process 

A steering group made up of OD professionals and managers from each organisation (NHS and 4 local Councils) led the work from  specification, invitation to tender, interviewing bidders, appointing a preferred  bidder, overseeing the development process including piloting, testing with  'early adopter' teams to finally delivering the finished product to the target  audience. 

The specification for the Toolkit was informed through desk research into other team development frameworks, a scoping workshop with existing team leaders, trainers and managers to find out what they would have valued in their development journey, discussions with existing teams and our own experience of facilitating team development. 

Following a competitive tendering process, Animate Consulting was appointed as the preferred bidder and they worked closely all through the design and implementation process with the Steering Group and NHS Lothian OD Team. 

Pilot teams helped test out materials during the design phase and when the final draft toolkit was ready, it was tested out on some early adopter team leaders and then further refinements were made. 

The toolkit is now available to teams on HSCP and NHS Lothian Intranets and also in hard copy folders which was what we set out to do. 

Explain how parties on this project were brought together 

The parties on this project were NHS Lothian, Midlothian HSCP,  Edinburgh HSCP, West Lothian HSCP and East Lothian HSCP and they were brought together by the OD team in NHS Lothian as part of the process of developing HR &  OD plans in each HSCP. Through this process, strong relationships were developed and trust established. When the idea of pooling resources to meet a common need was suggested, it was agreed wholeheartedly and the work began on this exciting project. The Deputy Director of HR &OD at NHS Lothian got agreement from the 4 Chief Officers to jointly fund the project. During the design and implemetation phase, NHSL OD team played a key role in liaising with Animate and the Steering Group. 

What were the challenges, and how were they overcome? 

The main challenge for us was working in uncharted territory across 5 organisations and trying to articulate to an external company exactly what we needed when we sometimes didn’t know ourselves. The process of integration also took a lot longer than anticipated and so we struggled to find pilot teams in the early phase of design or on which to base a case study. The first draft of the toolkit also did not feel right but we worked constructively with Animate until we were all happy. We also did not have an endless pot of money and had to keep within budget. 

We overcame these challenges by working together across organisational boundaries, being open to each other's ideas and being comfortable with the ambiguity. Strong leadership, trust and perseverance helped too along with support and encouragement from colleagues in each organisation. Ultimately, holding onto the belief that this was the right thing to do for teams was a powerful force. 

This was actually mirroring the challenges being faced by the very same teams we were trying to help.  We realised this at the time and regarded it as a rich learning experience. 

What are the measurable achievements, expected benefits and impact on patient care and quality of healthcare of your project? 

The measurable achievement is that we have delivered a Toolkit. It is on the Intranet of each organisation with hard copies being distributed. 

Feedback from Early adopters has been positive with the following comments:

Ultimately the benefits of effective team-working will be for the service users as they receive better services and ultimately better outcomes.  These outcomes are articulated by the Scottish Government and are included in the Toolkit Modules on Monitoring Progress. In terms of measurable achievements, teams are encouraged through the toolkit to translate these outcomes into something meaningful and measurable to them. There are 9 outcomes including: 

• People who work in health and social care services feel engaged  with the work they do and are supported to continuously improve the  information, support, care and treatment they provide
• Resources are used effectively and efficiently in the provision of  health and social care services 

Effective teamworking also has benefits for individual team members and the organisation as a whole. Research evidence is pretty conclusive  E28093 organisations that structure work effectively around teams are far more successful than those who don't. 

Where multi-professional teams work together: patient satisfaction is higher; health care delivery is more effective; there are higher levels of innovation in the provision of new and improved ways of caring for patients; lower levels of staff stress, absenteeism and turnover; and more consistent communication with patients. 

This Toolkit is expected to encourage and facilitate teams and team leaders taking charge of their own development, which they otherwise may not have had the confidence, time, skills or resources to do. 

How does your project demonstrate sustainability and transferability, and what are your lessons learnt? 

The Toolkit was written in such a way that continual updates would not be required and could be used by teams in a number of different settings from community, acute, health, social care, 3rd sector, voluntary, GP practice. 

The online nature of the Toolkit means that some updates can be made and additional modules added if required. 

In terms of transferability,  interest has been shown from other NHS Organisations across Scotland for use in their HSCPs. 

Lessons learnt: 

• be as clear as you can about what you are trying to achieve and  hold onto this in key moments of choice 
• build in some flexibility but have timescales agreed
• keep a record of the journey 
• gain sponsorship from leadership and keep them informed 
• involve people in the planning and design 
• test out ideas on people who will be using your product 
• take every opportunity to talk about your project 
• if things are not right, have the courage and say something 
• use language which will be understood - no jargon 
• be open to changes along the way and be prepared to change track 
• be comfortable with ambiguity